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Name of Departing Employee: _______________________ Date of Departure: ____ Department: _____________________ Current Position: Manager: ______________________________________________________________ Person Conducting

the Interview: _____________________________ Date: ________

Reason for Leaving (Voluntary/Involuntary):

1. Reasons for leaving? Other Position Opportunity for Advancement Too Demanding or Stressful Benefits and Pay Relocation Medical Other (specify) Dissatisfaction with Work Dissatisfied with Type of Work Working Conditions Child Care Hours Supervision

2. If you are leaving for a new position, what makes it more attractive than the one you are leaving? Wage and Benefits Opportunities and Advancement Working Conditions Hours Location Responsibility Flexibility Other (specify)

3. How would you rate the following?

Performance Reviews __________________ Opportunity for Advancement Training Received Company Policies and Practices Responsibilities Hours Support by Management Work Load Salary Benefits

Excellent

Good

Fair

Poor

Comments

__________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________

Did you feel sufficiently trained and oriented for your job? Please comment:

1. Did you feel that you were treated with respect & responsibility by co-employees and
management? Please comment:

2. Do you feel that you could have done your job better if you were provided different or better resources? What resources would you have needed? Please comment:

3. Did you feel free to discuss suggestions or problems with your supervisor or manager? Please comment:

4. Did you witness or have knowledge of any unethical or illegal acts or practices
engaged in by any employees of this company? Please comment:

5 . Are there any specific organization, department, human resource, supervisory practices, or working conditions that either led to your decision to resign or that you feel are detrimental to a satisfactory working relationship? If so, what suggestions do you have on how to address or improve these areas?

5. Do you have any suggestions for improving the quality of our goods or services? Please comment:

4. Did your Supervisor: Yes Demonstrate fair and equal treatment? Provide recognition on the job? ____________________ Keep employees well informed? _____________________ No Comments ____________________

Make themselves available for discussion of any problems or potential problems? _____________________ Encourage feedback? _____________________ Explain the position and responsibilities of the job you held? _____________________

5. What is your opinion of the job you had with us? ___________________________________________________

6. What were some of the frustrations you experienced in the performance and execution of job responsibilities?

Considering everything, how would you rate your level of satisfaction with your employment here?
Very Dissatisfied

10

Very Satisfied

12. Do you have any suggestions for improving customer relations in this company? Please comment:

13. Do you have any suggestions for improving employee motivation in this company? Please comment:

7. Would you be willing to stay with our company under a more satisfactory arrangement?

Yes

No

What changes would be required? _______________________________________________________________ _____________________________________________________________________________ _____________

8.

WHAT NEXT? What are you going to do?

If employment, what sort of job and at what level?

If employment, what attracted you to your new job?

If employment, who will be your new employer?

If employment, how does your new job differ from your current one?

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